Neuromonitoring in Lateral Approaches for Lumbar Interbody Fusion: A Systematic Review

Nie, James W.; Hartman, Timothy J.; Zheng, Eileen; MacGregor, Keith R; Oyetayo, Omolabake O; Singh, Kern

doi:10.1016/j.wneu.2022.10.031

Cited by 4 publications

(3 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…80 According to a recent systematic review of 34 contemporary studies on lateral approaches for lumbar interbody fusion, neurologic complication rates remained high despite the implementation of unimodal or multimodal IONM. 81 However, only 2 of the included studies examined LLIF and OLIF with/ without IONM. As a result, additional prospective studies are needed to better understand the advantages and limitations of different IONM modalities, including those without IONM altogether.…”

Section: Intraoperative Neuromonitoring During Lumbar Spine Surgerymentioning

confidence: 99%

“…Despite the use of IONM during LLIF, sensorimotor deficits have been reported to be as high as 36% 80. According to a recent systematic review of 34 contemporary studies on lateral approaches for lumbar interbody fusion, neurologic complication rates remained high despite the implementation of unimodal or multimodal IONM 81. However, only 2 of the included studies examined LLIF and OLIF with/without IONM.…”

Section: Intraoperative Neuromonitoring During Lumbar Spine Surgerymentioning

confidence: 99%

See 1 more Smart Citation

Use of Intraoperative Neuromonitoring: A Review

Vucicevic,

Salazar,

Federico

et al. 2024

Contemporary Spine Surgery

View full text Add to dashboard Cite

show abstract

Section: Intraoperative Neuromonitoring During Lumbar Spine Surgerymentioning

confidence: 99%

Section: Intraoperative Neuromonitoring During Lumbar Spine Surgerymentioning

confidence: 99%

Use of Intraoperative Neuromonitoring: A Review

Vucicevic,

Salazar,

Federico

et al. 2024

Contemporary Spine Surgery

View full text Add to dashboard Cite

show abstract

“…However, the proliferation of IONM has fallen into question based on effectiveness and costs because of a lack of evidence supporting its benefit for specific procedures. [4][5][6][7][8] One application of IONM that has not been well investigated is during lumbar anterior approach surgery. 9,10 This approach has the benefits of providing broad access to the interbody disc space allowing the implantation of large, lordotic anterior lumbar interbody fusion (ALIF) cages as well as total disc replacements (TDRs).…”

Section: Introductionmentioning

confidence: 99%

Is the Use of Intraoperative Neuromonitoring Justified During Lumbar Anterior Approach Surgery?

Blumenthal,

Edionwe,

Courtois

et al. 2024

Int J Spine Surg

View full text Add to dashboard Cite

Background: Intraoperative neuromonitoring (IONM) became widely used in spine surgery to reduce the risk of iatrogenic nerve injury. However, the proliferation of IONM has fallen into question based on effectiveness and costs, with a lack of evidence supporting its benefit for specific spine surgery procedures. The purpose of this study was to evaluate the use of IONM and the rate of neurological injury associated with anterior lumbar spinal surgery.Methods: This was a retrospective study on a consecutive series of 359 patients undergoing lumbar anterior approach surgery for anterior lumbar interbody fusion (ALIF), total disc replacement (TDR), or hybrid (ALIF with TDR) for the treatment of symptomatic disc degeneration. Patients undergoing any posterior spine surgery were excluded. Operative notes were reviewed to identify any changes in IONM and the surgeon's response. Clinic notes were reviewed up to 3 months postoperatively for indications of iatrogenic nerve injury.Results: There were 3 aberrant results with respect to IONM. Changes in IONM of a lower extremity occurred for 1 patient (0.3%). The surgeon evaluated the situation and there was no observable reason for the IONM change. Upon waking, the patient was found to have no neurological deficit. There were 2 cases of neurologic deficits in this population, which were classified as false-negatives of IONM (0.56%, 95% CI: 0.1% to 1.8%). In both cases, the patients were found to have a foot drop after the anterior approach surgery.Conclusion: In this study, there was 1 false-positive and 2 false-negative results of IONM. These data suggest that IONM is not beneficial in this population. However, many surgeons may feel obligated to use IONM for medicolegal reasons. There is a need for future studies to delineate cases in which IONM is beneficial and the type of monitoring to use, if any, for specific spine surgery types.Clinical Relevance: This study questions the routine use of IONM in anterior lumbar approach surgery for the treatment of symptomatic disc degeneration. This has significant implications related to the cost of this practice.Level of Evidence: 4.

show abstract